Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Polyunsaturated fatty acids (PUFAs), particularly omega-3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found in fish oil, have a moderate level of scientific evidence supporting their use in the management of rheumatoid arthritis (RA). Several randomized controlled trials and meta-analyses have shown that supplementation with omega-3 PUFAs can lead to a reduction in the number of tender joints, duration of morning stiffness, and overall disease activity in RA patients. The proposed mechanism involves the anti-inflammatory effects of omega-3 fatty acids, which are thought to compete with arachidonic acid (an omega-6 PUFA) for incorporation into cell membranes, thereby decreasing the production of pro-inflammatory eicosanoids. A 2017 Cochrane review and other systematic reviews have found that omega-3 supplementation results in small but significant improvements in symptoms, and may allow some patients to reduce their use of nonsteroidal anti-inflammatory drugs (NSAIDs). However, the effects are generally modest, and omega-3s are not considered a replacement for standard disease-modifying antirheumatic drugs (DMARDs). The evidence for other polyunsaturated fatty acids, such as omega-6 or omega-9 PUFAs, is less robust. In summary, scientific evidence moderately supports the adjunctive use of omega-3 PUFAs for symptom relief in RA, but they should not be relied upon as sole therapy.

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